Side Effects

Malcolm Gladwell, Revenge of the Tipping Point

In the year 2000¹, I was still living in Norfolk, Virginia, and teaching at Old Dominion². I don’t think we fully appreciate, these days, how anxious folks were leading up to that year. There was a weird generational Venn diagram: one circle contained older folk who understood just how crucial institutions like banks, hospitals, government organizations, et al., were to the smooth operation of society. The other, much younger, had an intuitive sense of the power of computers and how quickly they’d overtaken that vital infrastructure. The sliver of overlap, which would eventually expand, contained those of us who were worried about Y2K, the (potential) impending failure to our systems caused by the fact that most of them tracked the calendar year using 2 digits. Of course, it ended up turning out alright, mainly because there were enough people in the overlap treating it seriously and taking strides to anticipate the problem.

I was a little flabbergasted when I realized recently that Malcolm Gladwell’s The Tipping Point was published in 2000. This realization was triggered by the publication (last fall) of Gladwell’s followup The Revenge of the Tipping Point.

The idea of a “tipping point” was such a successful idea at the time that it ended performing the very phenomenon that Gladwell described. It entered common parlance to the point that no one bothers citing Gladwell—like kleenex or xerox, the “brand” became the thing. Given how much value we still attribute to the idea of virality in our culture, how even traditional institutions have shifted their business models to the sort of social engineering the book describes, I think there’s a claim to be made for Tipping Point as one of the most fundamentally influential books of the 21st century.

At the same time, Gladwell certainly has had his share of critics. They accuse him of engaging in pop social science, a brand of creative nonfiction more concerned with telling a good story than with getting the science right. Here’s one from The Atlantic, for instance, that argues “the Gladwell formula is at last exhausted.” I don’t know that that’s been the case: I’ve listened to a few seasons of Gladwell’s podcast Revisionist History and enjoyed it. I think it’s perhaps more accurate to say that Gladwell’s style is better suited to the scope of a podcast episode. He’s always been adept at examining anecdotes or stories from unexpected angles, and where he sometimes gets into trouble (imho) is when he tries to piece them together into larger, book-sized claims. Sometimes they gel; sometimes they don’t. I do think that Gladwell follows a particular storytelling formula, one that matches my own curiosity about things, but podcasting allows him to be more paratactic, and that’s ultimately a better fit.

Revenge is a book that follows the Gladwellian formula in more than one sense. It certainly draws on individual anecdotes to illustrate principles, but those principles in turn lightly revise (or perhaps crystallize) the principles from the original Tipping Point. The three “rules” he offers in his original analysis—The Law of the Few, Stickiness, Context—become in the new book Superspreaders, Group Proportions, and Overstories³. He describes them as a “new set of theories,” a claim about which I found myself a little ambivalent. I do think there’s something a bit different about this book, but I’ll get into that below.

The overarching story that unites Revenge is a serious one. The book begins with an annotated transcript from a Congressional hearing (“A group of politicians has called a hearing to discuss an epidemic.“). Gladwell doesn’t say so until the conclusion, but these are transcripts from the hearing regarding the Sacklers’ (and Purdue’s) role in the opioid epidemic. It’s infuriating to watch the Sacklers weasel their way through passively voiced answers. Gladwell writes

Does anyone expect the witnesses to admit that they started an epidemic? Probably not. A squadron of lawyers has clearly coached them beforehand in the art of self-preservation. The righteousness with which they deny responsibility, however, suggests another possibility: that they have not yet accepted their own culpability, or that they started something that spiraled out of control in a way they could not understand.

I’ll be honest, I’m not sure how much faith to put in Gladwell’s equivocation here. He writes: “That’s the revenge of the Tipping Point: The very same tools we use to build a better world can also be used against us.” A little later, he explains that “We need to be honest about all the subtle and sometimes hidden ways we try to manipulate [epidemics].” I’ll say more about this momentarily, but I’m not sure that (25 years and a massive shift in our media ecosystem later) it’s entirely fair to describe the ideas from The Tipping Point as these secret, natural forces that rendered them incomprehensible, unintentional, or forgivable.

The remainder of Revenge takes its time with its new theories, explaining the principles listed above, before returning in the Conclusion to the opioid epidemic. Gladwell isolates several key factors to this story. Paul Madden’s crusade in California to crack down on illicit prescription drugs by installing accountability steps (later adopted by several other states (inc. New York, Illinois, and Texas). These states, where doctors are legally required to track and report their prescriptions (in triplicate), end up being far less susceptible to the epidemic: “Illinois had one-third the opioid use of Nevada and West Virginia. New York had half the problem Tennessee did. Of the triplicate states, only Idaho came anywhere close to the national average.” Madden’s “overstory” is that certain drugs require additional oversight.

Gladwell returns to Purdue to discuss the second principle, that of superspreaders. Not only did Purdue take the path of less resistance, focusing their efforts on non-Madden states, but they drew on the expertise of McKinsey to “supercharge” their sales efforts,

OxyContin’s success didn’t ride on the backs of most American doctors, or even some American doctors. It was an epidemic driven by the tiny fraction of doctors in Deciles 8, 9, and 10—roughly 2,500 doctors who among them wrote a staggering number of prescriptions. In the language of McKinsey’s E2E, the physicians in those top three groups were the “Core” and “Super Core.”

…Between 2007 and 2016, the number of doctor visits by OxyContin sales reps goes up by nearly a factor of five. And that’s not to every doctor in Tennessee; that fivefold increase was directed at the superspreaders.

By the time that the Oxy epidemic had hit its stride, according to Mathew Kiang, “the top 1 percent of doctors ‘accounted for 49 percent of all opioid doses.’” The superspreaders to whom Purdue dedicated its resources “prescribed 1,000 times more opioid doses than the average doctor.”

The “third act” of the epidemic draws on the principle of group proportions. When Purdue reformulated their drug (in part because their patent was about to expire), it shifted those group proportions: “prescription-drug users who couldn’t crush up their OxyContin pills [because it was reformulated in consistency] simply switched to heroin and fentanyl.” And as a result

Prescription-drug deaths—the least of the three evils—go up slightly over the next decade. But the number of fatal overdoses from heroin go up 350 percent by 2017. And the number of people killed by fentanyl goes up 22-fold, from what is basically a rounding error to a problem that dwarfs every previous opioid crisis in history.

It’s at this point that Gladwell returns to the testimony with which he begins the book:

“I have tried to figure out, was—is there anything that I could have done differently, knowing what I knew then, not what I know now,” Kathe Sackler said. Remember that quote from the very beginning of the book? She went on: “And I have to say, I can’t.”

Gladwell remarks that “That is very hard to accept,” but if I’m being honest, I expected a little more. Tucked away amongst the various epidemic principles are other details about the decisions that the Sacklers made: they intentionally increased the dosage of oxycodone in their drug, they chose to “remove the acetaminophen governor’s switch” from it, they marketed their “special extended-release tablet,” they outright and routinely lied about the addictive properties of their drug, they spent $86 million on McKinsey to strategize and optimize their profit, they targeted areas where regulations were weakest, and then they focused their salesforce on the most ethically corrupt doctors they could fine, and incentivized those people to launch the most horrific medical epidemic in the history of our country. And they did all of this gleefully: “At Purdue headquarters, the new drug was the focus of much excitement. ‘OxyContin,’ said one of the original Sackler brothers, ‘is our ticket to the moon.’”

Describing Sackler’s testimony as “hard to accept” implies that there’s some truth to it, that this sort of epidemic was beyond their control, even as they devoted tens of millions of dollars to triggering just such an outcome. The ambivalence here, honestly, is harder to accept than the testimony. Anything out of Sackler’s mouth is just the scorpion talking.

image from What is Social Engineering?

I mentioned above Gladwell’s gloss on what he means by the title of his book (“The very same tools we use to build a better world can also be used against us.”), but the more that I thought about it, the less satisfying I found this interpretation. And part of that is I don’t think I’d characterize the original book as offering “tools we use to build a better world.” I looked the book up on Amazon (in part to learn that I’d purchased it hot off the paperback presses in 2002), and it’s pitched as a book about “the captivating science behind viral trends in business, marketing, and human behavior,” one that is already “changing the way people throughout the world think about selling products and disseminating ideas.” Put bluntly, The Tipping Point was not a book about building a better world⁴, unless one genuinely believes that corporations and marketing executives are somehow altruistic.

Gladwell’s closing paragraph hints at a different interpretation of its title. He writes

The tools necessary to control an epidemic are sitting on the table, right in front of us. We can let the unscrupulous take them. Or we can pick them up ourselves, and use them to build a better world.

On the one hand, then, Revenge is a book about the opioid epidemic. But it’s also a retrospective look at what happened when the unscrupulous took up the tools that Gladwell offered back in 2000. The hotshots at McKinsey were, if nothing else, the very model of the target audience for the book upon which Gladwell built his entire career. I have to wonder what it must be like to write a wildly popular book, one that laid those tools out “on the table,” and then look back 25 years later and see what has been made of them: our shambles of a government, the collapse of the 20th century media ecosystem, the dissolution of monoculture, replaced by thousands (millions?) of voices all trying to tip their content into virality, the massive extent to which any kind of social or institutional trust has all but vanished, and so on.

I don’t mean to lay all of this at Gladwell’s feet—that would be patently unfair. But by the end of his book, I really wondered whether and how much he identified with Kathe Sackler, or at least the bind that her testimony put her in. Gladwell seems to me to be questioning how much responsibility one person can even feel (much less admit) for forces that they’ve unleashed. It’s not unlike the process of enshittification that Cory Doctorow describes. It’s not like these executives wake up one day and decide to make their services worse. When checks and balances are removed, and their growth-at-all-costs mindsets are given full throat, quality and user satisfaction become part of the “costs” sacrificed upon their neoliberal altars.

It’s entirely unrealistic to imagine that the Malcolm Gladwell of the late 90s, the New Yorker staff writer who hadn’t yet published a book, would look at the articles that would form the basis of Tipping Point, at the million-dollar advance he received for doing so, and expect him to be capable of speculating what impact those ideas might have or how they might be exploited. And yet, I can imagine that he might look back at that first book, at its curiosity and optimism, and reflect upon how it didn’t quite live up to the ideal of “building a better world.” Perhaps the “revenge” is less about the phenomenon itself and more about the way that the “unscrupulous” turned his book into a playbook for creating the hellscape we find ourselves in today. And perhaps he might find that line of thinking “very hard to accept.”

Which is all to say that, by the end of Revenge, I found myself wondering if it wasn’t, in fact, a subtle apology for that first book. In the opening chapter, Gladwell promises to “look at the underside of the possibilities I explored so long ago,” but this itself feels like an echo of medications’ lists of “side effects.” Is the story of the opioid epidemic an underside of those possibilities, or a conscious and well-funded manifestation of them?

Ultimately, I suppose that this is one of those “debate” questions that’s fundamentally impossible to decide, like assigning percentages to how much one team won a game vs the other team losing it. But I could imagine feeling some degree of responsibility for how one’s ideas have been taken up, even as one would have objected to it in the moment had one known. Less a confession of wrongdoing than a subtly shaded apology for the consequences, perhaps.

That’s all I’ve got for today. More soon.

1. I can’t help but think of Conan O’Brien when I type that.

2. In the fall of 2000, I tested the job market and interviewed for the position I took at Syracuse. In other words, this fall will mark the 25-year anniversary of that offer.

3. The idea of “superspreaders” comes from COVID discourse, but I’m not sure why Gladwell opted for overstory, a word that feels like it’s intended as a translation/simplification of metanarrative

4. In this sense, this “science” bears more than a strong resemblance to rhetoric itself, which was a big part of my own interest in network studies. Much to the dismay of many whom I’ve written about over the past couple of years, there’s nothing intrinsically “good” about rhetoric (or tipping points).